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动脉血气分析采血技术的质量控制
动脉血气分析(Arterial Blood Gas Analysis,ABGA)是指对动脉血中不同类型的气体和酸碱物质进行分析的过程.血气分析能反映机体的呼吸功能和代谢功能,是诊断呼吸衰竭和酸碱平衡紊乱可靠的指标和依据,对各种急,危、重症,尤其是呼吸衰竭的诊断,治疗和抢救,以及低氧血症的判断,指导氧气治疗和机械通气均具有重要意义<'[1-4]>.
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不同动脉采集血气分析标本的临床效果比较
ICU收治的多为伴有呼吸衰竭使用机械通气的急危重病人,常需要血气分析结果来判断机体是否存在缺氧和缺氧的程度,是否存在酸碱失衡,调整呼吸机参数及做预后判断.及时正确采集动脉血气分析标本是血气分析结果是否准确的标准之一.我科2007年1月-2008年2月为280例危重病人分别采用足背动脉和股动脉采血,对两组的采血成功率、误穿静脉的发生率、血肿发生率、疼痛反应、按压时间做了比较.现报道如下.
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高原小儿外科感染性休克探讨
本文对105例高原小儿外科感染性休克进行了总结.临床观察和实验室资料表明,高原地区健康小儿的血液流态具有粘、浓、聚三大特点,微血管在缺氧环境下处于痉挛代偿状态.感染性休克时血管痉挛明显加重,持续时间长,代偿机能差,休克早期就会出现微循环障碍,因而高原小儿感染性休克具有发病急、进展快,病情重、病死率高等临床特点.早期诊断、早期治疗对于提高抢救成功率,降低病死率有重要意义.
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先天性横膈疝疗效观察
先天性横膈疝是新生儿常见的呼吸急症之一,严重地威胁着患儿的生命.其发病率一般统计为1:8,000~10,000次活产.由于围产医学的发展,文献中报导此病的诊断率已有明显提高,使生后24小时以内的手术率高达90%,总病死率却由原来的25%上升至35%.
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脐动脉血气分析在围生期医学领域的正确应用
近10余年来,脐动脉血气分析的临床意义和价值日益受到国际围生期医学界的重视,已被公认为是评价胎儿氧合和酸碱状况的客观、可靠的依据[1-5].
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Objective: To investigate the classification and incidence of acid-base disturbance (ABD) in the patients with post-traumatic multiple organ dysfunction syndrome (MODS).Methods: A total of 119 patients with MODS were examined with arterial blood gas analysis and serum electrolytes detection for 675 times in this study.Results: Different types of ABD existed in 647 times out of 675 times (95.9%) of blood-gas analyses. There were 270 times (41.7%) of simple ABD, 271 times (41.9%) of double ABD and 106 times (16.4%) of triple ABD. Among which, 404 times (62.4%) were in respiratory alkalosis (RAL), 332 times (51.3%) in metabolic acidosis (MA), 227 times (35.1% ) in metabolic alkalosis (MAL) and 167 times (25.8%) in respiratory acidosis (RA). In this study, 79 cases (66.4%) out of 119cases with MODS died from these kinds of ABD.Conclusions: It suggests that in the early stage of MODS, RAL with or without hypoxemia may exist, and later on, MA or even triple ABD may occur. In order to detect and correct the primary disorders as early as possible, it is important to keep the balance of hydrolyte. The treatment of primary diseases is also important.Disorders of acid-base balance were corrected according to pH standard values, anion gap (AG) and the potential [HCO3- ] were also calculated simultaneously. When pH was more than 7.50 or lower than 7.20, it is necessary to give drugs of acidity or alkalinity to the patients with ABD to maintain pH value within a normal range.
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Objective:To explore the value of arterial blood gas analysis and electrolyte determination in the diagnosis of neonatal asphyxia.Methods: A total of 100 neonates with asphyxia who were admitted in our department from March, 2013 to March, 2014 were included in the study and divided into the mild asphyxia group and the severe asphyxia group according to Apgar scoring. Moreover, 50 normal neonates were served as the control group and used for comparative analysis. AVL blood-gas analyzer was used to detect the levels of pH, PaO2, HCO3-, BE, PaCO2, K+, Na+, Cl-, and Ca2+.Results:The concentrations of pH, PaO2, HCO3-, and BE in the severe asphyxia group were significantly lower than those in the mild asphyxia group and the control group, while PaCO2 level was significantly higher than that in the mild asphyxia group and the control group. The comparison of the various indicators between the control group and the mild asphyxia group was not statistically significant. The comparison of serum K+, Na+,and Cl- levels among the control group, the mild asphyxia group, and the severe asphyxia group was not statistically significant. The serum Ca2+ level in the severe asphyxia group was significantly lower than that in the mild asphyxia group and the control group, while the comparison between the mild asphyxia group and the control group was also statistically significant.Conclusions:Blood gas analysis and electrolyte determination to the arterial blood in neonates can compensate for the insufficiency of Apgar scoring and provide an objective evidence for the diagnosis of neonatal asphyxia and the estimation of severity degree. Clinical combination with Apgar scoring is of great significance in enhancing the diagnosis of neonatal asphyxia and the accuracy of severity evaluation.